Pica (Allotriophagy): An Underestimated Risk Factor for Severe Leptospirosis (Weil's Diseases)? Report of a Leptospira Septic Shock Successfully Managed with ECMO.

Leptospirosis is a zoonosis caused by infection with pathogenic strains of the bacterium Leptospira. The disease can be complicated by pulmonary hemorrhages and acute respiratory distress syndrome, with the mortality rate increasing to 51-100%. We report the case of a 37-year-old man who was admitted to the emergency department with a 6-day history of fever, weakness, vomiting and diarrhea, followed by jaundice. On admission, he presented leukocytosis, thrombocytopenia and acute liver and kidney injuries. His clinical course was critical, as it was immediately complicated by sepsis and severe respiratory failure, requiring haemodialysis, mechanical ventilation and broad-spectrum antibiotic therapy. In the following days, a veno-venous extracorporeal membrane oxygenation (VV-ECMO) was started due to a dramatic deterioration in respiratory function; 20 h later, it was switched to veno-arterial ECMO because of refractory cardiogenic shock. Hantavirus or Leptospira infection etiology was suspected, so penicillin G and methylprednisolone were initiated as an empirical therapy and subsequently confirmed after a laboratory diagnosis of leptospirosis. Although the clinical course was further complicated by hemorrhagic pneumonia, a gradual, full recovery occurred, and the patient was discharged from the hospital. After excluding other sources of contact with Leptospira-infected material, an unsuspected abnormal eating behavior was identified as the most probable cause of the patient's Leptospira infection.

Rescue extracorporeal membrane oxygenation in a young man with a stab wound in the chest.

A 27-year-old man with haemorrhagic shock and acute cardiac tamponade due to a stab in the chest underwent successful resuscitation and surgical repair of the right ventricular perforation thanks to the use of extracorporeal membrane oxygenation (ECMO) in the emergency department. To the best of the authors' knowledge, this is the first report around the use of ECMO to rescue a victim of a penetrating cardiac trauma. The physicians who have portable ECMO device should be aware of this option when a life-threatening internal bleeding in haemodynamically unstable patients could be quickly controlled by surgery, even if performed in ill-suited settings.

A population-based study on overt heart failure in Lombardy (survey of hospitalization in 1996 and 1997).

BACKGROUND: The aim of this study was to get updated information about the incidence and outcome of heart failure hospital admission in the whole population of the largest Italy region. METHODS: The Lombardy regional database of hospital records (Information System and Quality Control Bureau) provided the requested information: all the heart failure cases admitted to all the institutions of the region were selected by the ICD9 code of congestive heart failure (428-) as the principal or secondary diagnosis. The available data included: diagnosis and surgical procedures (up to four), date of birth, dates of admission and discharge, outcome, DRG code, discharge unit code, gender. The data so obtained concern the hospital discharges in 1996 and 1997. RESULTS: 32,093 cases were selected. The mean ages were 74.1 +/- 11.5 years for males and 80.6 +/- 10.7 for females in 1996, and 71.8 +/- 11.7 for males and 78.3 +/- 10.6 for females in 1997. Most of the cases were classified as appertaining to DRG 127--pure heart failure (56.7%). Heart failure associated with myocardial infarction accounted for 7.3% of cases. The remaining cases (36.0%) were classified as appertaining to heterogeneous medical and surgical DRGs. In 1997, the in-hospital mortality was 14.7% for patients aged > 80 years; 9.7% for patients aged between 71 and 80 years; 7.4% for patients aged between 61 and 70 years and 6.9% for patients < 61 years of age with the exclusion of pediatric cases. The in-hospital mortality was different between discharge units: 2.8% of in-patients discharged from cardiology units, and 10.3% of in-patients discharged from general medicine units. The readmission rate at 1 month was 5.49% whereas that within 1 year was 14.3%. CONCLUSIONS: Heart failure mortality differences between hospital units are not explained by age and by comorbidity. The readmission rate was lower than in previous reports.